Children orphaned by the AIDS epidemic peer through the window of the Tithanizane Orphan Care Center in Ndirane township, the biggest shantytown in Malawi

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 THE HIV EPIDEMIC is creating “a crisis unprecedented except in times of war,” said Dr. Peter Piot, executive director of UNAIDS.
       Making matters worse, being an AIDS orphan carries a stigma as infectious as the virus itself, said Piot. “If your father died in war, you’re a hero. He died of AIDS, you’re [an outcast].”
       That’s why UNAIDS, UNICEF and USAID, which jointly released the “Children on the Brink” report here at the International AIDS Conference, want to get the word out. Their hope is that the shocking figures will propel efforts to turn the tide.
       “It’s important to keep the momentum going,” said UNICEF chief Carol Bellamy. Already, she noted, the organizations are helping to fund 75 programs in 22 countries that work with children affected by HIV.

       The programs aim not only to provide orphans with a roof over their heads and food on their plates, Bellamy said, but also to ensure the youngsters attend school and have access to health care.
       Children whose parents become ill often are forced to leave school to care for them or get a job to support the family, she explained.
       
FAMILY SUPPORT
       The best way to deal with the crisis is not to place the children in costly orphanages where they know no one, Bellamy added, but to support their extended families and communities to help them cope.
       The alarming projections are already compelling young people whose families or friends have lost parents to AIDS to get involved. Taiwo Benson told MSNBC.com that his organization, the Prevent AIDS Society of Nigeria, “provides food, school fees, anything a child needs to get on with his life.”

 Then there are other needs to fulfill, the ones that don’t carry a price tag. Sean Cox, head of For Us! NorthWest, said his Portland, Ore.-based group “gives kids a chance to be kids.
       “We were started by kids affected by HIV, for kids affected by HIV,” said Cox, whose father is HIV-positive. “There are support groups, recreational activities, even trips to Cirque de Soleil.”
       Piot said such programs provide an immeasurable service, as the vulnerable children try to replace the love they have lost. In the hardest hit areas, “even kids who have not yet lost a parent worry what will happen to them if they do. The strains on children who have been orphaned are even more tremendous.”
       
SKYROCKETING RATES
       Among other findings of the report, which its authors termed the most comprehensive statistics yet on AIDS orphans:
In 2001, there were 13.4 million children alive in the developing world who had lost their mom, dad or both to the disease. About 85 percent of these children were in Africa.
In 2010, 20 million African children — or almost 6 percent of all African youth — will have lost a parent to AIDS. That’s almost double the current 11 million orphans.
In 2001, about 2 million Asian children had lost a parent to AIDS. But with HIV infection rates in highly populous countries such as China projected to skyrocket, so too are the number of AIDS orphans there.

       The report covered Africa, Asia and Latin America and the Caribbean, home to 90 percent of HIV infections, Bellamy said. AIDS orphans were defined as children under 15 who had lost at least one parent to the disease.
       Neil Monk, a social scientist at the Association Francois-Xavier Bagnoud, said the figures vastly underestimate the true number of AIDS orphans. His projection: A staggering 100 million children will have lost a parent to the disease by 2010.
       “The report uses a cutoff of age 15 in defining AIDS orphans - an arbitrary number that has nothing to do with a child’s circumstances,” said Monk, who readily admitted he is not a statistician.
       “But I’ve met kids in Uganda who are 20 and orphaned,” he said. “They’re still in primary school, not because they are stupid but because they had to delay their education after losing a parent to AIDS.”

       USAID’s Karen Stanecki explained the use of age 15 as a cut-off, “because we’re using demographic information that breaks the data up into predetermined age groups. It’s the best available data we have.”

 The bottom line: “There are going to be huge numbers of orphans, in the tens of millions, perhaps hundreds of millions,” said Dr. Helene Gayle, who heads HIV efforts at the Bill and Melinda Gates Foundation. “The figure itself doesn’t really matter as long as you know what definition you are using.
       “We talk so much about people who are infected, we forget about those who are affected,” she said. “That’s the point, to find ways to give these children as normal a life as possible.”
       
       Charlene Laino is MSNBC’s executive health editor..